Should a Law Enforcement Officer (LEO) with borderline prolonged QTc interval, moderate repolarisation disturbances, and normal sinus rhythm be cleared for full duties despite being asymptomatic?

From the Guidelines

This asymptomatic law enforcement officer (LEO) should not be immediately cleared for full duties without further cardiac evaluation, given the ECG findings of repolarization abnormalities and a borderline prolonged QTc interval, as recommended by the most recent guidelines 1. The ECG shows repolarization abnormalities in multiple leads and a borderline prolonged QTc interval that warrant additional investigation.

• The officer should undergo further cardiac assessment including an echocardiogram, stress test, and possibly a cardiology consultation before returning to full duty.
• These repolarization disturbances in the mid-left precordial and inferior leads could represent several conditions including subclinical ischemia, left ventricular hypertrophy, or could be a normal variant.
• While the absence of acute ischemic changes is reassuring, the moderate repolarization abnormalities seen in multiple leads cannot be dismissed in an occupation that involves significant physical exertion and stress.
• The borderline QTc prolongation also requires clinical correlation as it may increase risk of arrhythmias under certain conditions, as noted in the guidelines for management of adult patients with supraventricular tachycardia 1. After completing these additional evaluations, if no significant cardiac pathology is identified, the officer could likely return to full duties with periodic follow-up, as suggested by the international recommendations for electrocardiographic interpretation in athletes 1.
• This cautious approach balances the officer's occupational needs with appropriate risk management for cardiac events that could occur during physically demanding duties.
• It is also important to consider the recommendations for athletes with suspected or diagnosed cardiac channelopathies, which emphasize the need for comprehensive evaluation and precautionary measures 1.

From the Research

Law Enforcement Officer Clearance for Full Duties

The decision to clear a Law Enforcement Officer (LEO) with borderline prolonged QTc interval, moderate repolarisation disturbances, and normal sinus rhythm for full duties despite being asymptomatic should be based on the available medical evidence.

• The studies 2, 3, 4, 5, 6 suggest that prolonged QTc intervals are associated with an increased risk of ventricular arrhythmias, in-hospital mortality, and poor outcomes in patients with various cardiac conditions.
• A study 2 found a strong significant positive correlation between QTc interval and ventricular arrhythmias (rho = 0.658, p < 0.001) and in-hospital mortality (rho = 0.314, p = 0.04) among STEMI patients.
• Another study 5 found that QTc prolongation before elective coronary angiography is associated with an increased mortality at six months and is significantly associated with lower left ventricular ejection fractions and higher left ventricular end-diastolic pressures.
• The available evidence 4, 6 also suggests that QTc interval prolongation can be a useful risk marker for identifying high-risk patients with acute coronary syndrome and can predict poor outcome.

Considerations for LEO Clearance

Given the available evidence, it is essential to consider the following factors when deciding whether to clear the LEO for full duties:

• The LEO's borderline prolonged QTc interval and moderate repolarisation disturbances may increase the risk of ventricular arrhythmias and other cardiac complications.
• The LEO's asymptomatic status does not necessarily mean that they are not at risk of cardiac complications.
• The LEO's occupation may involve physical exertion, stress, and other factors that could potentially trigger cardiac complications.

Recommendations

Based on the available evidence, it is recommended that the LEO undergo further evaluation and monitoring to assess their cardiac risk and determine the appropriate level of duty clearance. This may include:

• Consultation with a cardiologist to assess the LEO's cardiac risk and determine the appropriate level of duty clearance.
• Regular monitoring of the LEO's QTc interval and other cardiac parameters to assess for any changes or abnormalities.
• Consideration of alternative duties or modifications to the LEO's job responsibilities to reduce the risk of cardiac complications.